Generally speaking, the considerations involved in providing a surgical incision include adequate access to a subject area within the anatomy, minimal blood loss, maximum closure and healing potential, and minimal scaring.
Several elegant surgical incision techniques have been developed to address the foregoing. For instance the “Phannenstiel” incision used in abdominal surgery was developed to minimize the development of surgical site herniations.
With the advent of laparoscopic surgery, it has become apparent that small incisions have certain advantages. However, some surgeries present challenges that are beyond standard laparoscopic or totally open techniques. One of these is human breast surgery. In these instances, access is very important. However, aesthetic outcome is almost equally important.
Typical human breast surgery generally comprises either a periareolar incision or an inframammary incision or both. Other, more complex incision types are also available for various specific needs. For instance a triangular incision may be used where mass reduction is provided. A vertical incision may be used where maximum access is desired. Alternatively, a “b-flap” incision may be employed where specific reconstruction is indicated. This is an incision that extends from the vertical incision site to a selected lateral position. In some cases an incision is made in the umbilicus and access to breast is provided beneath the skin level.
Generally, opposing mechanical retractors are used to spread, open or enlarge an incision for appropriate access. The mechanical retractors may be moved in tandem to position the incision to maximize access and visualization. This action requires complicated and orchestrated action, usually involving two operators. An additional complication may arise when metallic retractors are employed in an environment where electrosurgical devices are in use. The potential for unintended electrical discharge is clearly present. This could result in burns that are difficult to anticipate and manage.
In view of the foregoing, there remains a need to provide surgical access to the human breast and other areas of the human body that provides acceptable access and further provides exceptional cosmetic outcome but which avoids the complications and risks of mechanical retractors.